Skip to main content
Medicine LibreTexts

6.4.4: 4. Clinical Evaluation- History and Examination

  • Page ID
    18325
  • \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)

    Objectives

    • Avoid unnecessary surgery
    • Do appropriate surgery
    • Avoid embarking on surgery that is beyond the scope of a surgeon e.g. tumour requiring neck dissection
    • Distinguish between submandibular lymph node and salivary mass

    Distinguishing lymph node from SMG mass

    • Unlike the parotid, there are no intraglandular lymph nodes
    • Lymph nodes are lateral/superficial to the SMG
    • Palpate the mass between a finger placed on the floor of mouth and another on the neck: lymph nodes are generally palpable only with the finger on the neck, as opposed to a SMG mass that is palpable between both fingers
    • If still uncertain, proceed to U/S or FNAC

    Suspicious for malignancy

    • Malignant tumours may have benign clinical features in 2/3 of cases
    • Rapid growth
    • Pain (30% of malignant tumours)
    • Extra-glandular extension
      • Adherence to mandible
      • Skin
      • Floor of mouth
      • Neurological deficits
        • Hypoglossal nerve
        • Lingual nerve
        • Marginal mandibular nerve
    • Cervical lymphadenopathy
    • Previous salivary cancer
    • Previous radiation to salivary gland region